Deciding between NCC and Stroke

[slavicman]

Hey all

I am a current PGY2 and struggling to decide between neuro-critical care and stroke. I would ideally practice both but would preferably avoid doing both fellowships. My interest in stroke initially propelled me into neurology. I've realized though that stroke also often deals with a high number of functional patients which I don't enjoy as much, and being in the neuro ICU has the satisfaction of dealing with patients that are all very truly ill.

I think another pro of NCC is that you're in a shielded unit with a set patient cap, whereas in stroke you can be called by anyone at anytime anywhere, and the stroke alert system is often abused to obtain a STAT neurology consult unfortunately. Neuro ICU also takes care of lots of stroke patients anyway. I also do miss dabbling in some medicine once in awhile and critical care was my favorite rotation during my prelim year.

I think the pro's of stroke is the 1 instead of 2 year fellowship. I think doing stroke would also make me feel being closer rooted to neurology, whereas in NCC I am concerned about becoming more of intensivist than a neurologist. Dealing with NSGY whom can override your plan on occasion is also frustrating. I am also interested in NIR which I was told has a better shot going through stroke than NCC fellowship.

I have limited knowledge on the overall lifestyle and compensation between the two. I would appreciate any advice on choosing between the two. Thanks.

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[BlueBleck]

I'd write to current NIR fellowships to ask for a coffee/zoom meeting. A lot of these neuro->NIR guys are workoholics and actually legitimately really nice. Especially the neuro trained ones. They get the struggle.

You'd be best served by more specific advice. I haven't seen any NIR regulars on SDN. Probably too busy doing q2 call.

My sense on the stroke fellowship trail is that this is a very fast moving field. Advice from several years ago could easily be outdated by now. Especially regarding the training landscape.

 

[Aldertonghen]

Hey all

I am a current PGY2 and struggling to decide between neuro-critical care and stroke. I would ideally practice both but would preferably avoid doing both fellowships. My interest in stroke initially propelled me into neurology. I've realized though that stroke also often deals with a high number of functional patients which I don't enjoy as much, and being in the neuro ICU has the satisfaction of dealing with patients that are all very truly ill.

I think another pro of NCC is that you're in a shielded unit with a set patient cap, whereas in stroke you can be called by anyone at anytime anywhere, and the stroke alert system is often abused to obtain a STAT neurology consult unfortunately. Neuro ICU also takes care of lots of stroke patients anyway. I also do miss dabbling in some medicine once in awhile and critical care was my favorite rotation during my prelim year.

I think the pro's of stroke is the 1 instead of 2 year fellowship. I think doing stroke would also make me feel being closer rooted to neurology, whereas in NCC I am concerned about becoming more of intensivist than a neurologist. Dealing with NSGY whom can override your plan on occasion is also frustrating. I am also interested in NIR which I was told has a better shot going through stroke than NCC fellowship.

I have limited knowledge on the overall lifestyle and compensation between the two. I would appreciate any advice on choosing between the two. Thanks.

A lot of good stroke fellowships have you be primary in the neuroICU (UTH, Columbia)- and people from these places in private practice do a lot of neuroICU coverage. Alternatively the 4 year Stroke-NeuroICU-NeuroIR options give you everything in 4 years.

 

[slavicman]

A lot of good stroke fellowships have you be primary in the neuroICU (UTH, Columbia)- and people from these places in private practice do a lot of neuroICU coverage. Alternatively the 4 year Stroke-NeuroICU-NeuroIR options give you everything in 4 years.

I didn't realize this. I assumed it would be easier for an NCC neurologist to practice both neurocrit and stroke rather than the other way around.

Are there any combined fellowships that do both NCC and Stroke besides JFK? I haven't seen any others.

 

[Asklepian]

You could do NCC fellowship only and take care of plenty of stroke patients. Plenty of neurohospitalists that provide high-level stroke care don't have the formal vascular fellowship. That's not to say it's not incredibly useful, but it isn't necessary unless you want to be a stroke director or in academia.

 

[CnsCrit]

Hey all

I am a current PGY2 and struggling to decide between neuro-critical care and stroke. I would ideally practice both but would preferably avoid doing both fellowships. My interest in stroke initially propelled me into neurology. I've realized though that stroke also often deals with a high number of functional patients which I don't enjoy as much, and being in the neuro ICU has the satisfaction of dealing with patients that are all very truly ill.

I think another pro of NCC is that you're in a shielded unit with a set patient cap, whereas in stroke you can be called by anyone at anytime anywhere, and the stroke alert system is often abused to obtain a STAT neurology consult unfortunately. Neuro ICU also takes care of lots of stroke patients anyway. I also do miss dabbling in some medicine once in awhile and critical care was my favorite rotation during my prelim year.

I think the pro's of stroke is the 1 instead of 2 year fellowship. I think doing stroke would also make me feel being closer rooted to neurology, whereas in NCC I am concerned about becoming more of intensivist than a neurologist. Dealing with NSGY whom can override your plan on occasion is also frustrating. I am also interested in NIR which I was told has a better shot going through stroke than NCC fellowship.

I have limited knowledge on the overall lifestyle and compensation between the two. I would appreciate any advice on choosing between the two. Thanks.

I'm biased as a NCC person, but a few things to think about:

NCC services are often not capped, actually I think uncapped NCC is more of the norm. Regardless, because there are only so many ICU beds and and only so many ICU nurses trained in neuro or in device management, things tend to even out and the census will usually be within a stable range day to day. Stroke service will often be abused as you said since if theres a code, you go. If someone asks me to admit a patient that isn't appropriate for NCC service, I can decline.

In NCC you manage a wider variety of neurological issues than stroke. Sure stroke is a bread and butter diagnosis but if you want to be you'll be at least as much a well rounded neurologist as a stroke doc. It really depends on you and how much you choose to develop your skills as an attending.

Politics and NSGY are part of NCC, you're automatically part of a large team and you have to learn to manage that. Some people enjoy that more than others.

Lifestyle isn't necessarily that different, it depends on the particular job you pick. Do you want to do clinic? Do you have to do home call? How many weeks do you work and what does a week mean? All these things vary a ton. You give up a year of attending income for NCC. Salaries are probably higher in NCC but I didn't interview for stroke jobs. But again it depends on many factors. There are lots of community gen neuro jobs that pay more than some stroke or NCC jobs.